Skip to main content

Advertisement

SpringerLink
Log in

Colon interposition for esophageal replacement: a single-center experience

  • Original Article
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Background

Gastric tube interposition has become the method of choice for esophageal replacement after esophagectomy. Colon interposition, on the other hand, is widely considered to be a method of last resort, associated with high morbidity and mortality. The present study reviews our experience with colon interposition for esophageal replacement.

Patients

Nineteen consecutive patients undergoing colon interposition for esophageal replacement between 1 January 1994 and 31 July 2001 were reviewed. Outcome was compared with international publications on colon interposition as well as with our results following gastric tube interposition (fundus rotation gastroplasty).

Results

Fourteen men and five women with a median age of 68 years (range 44–78) underwent colon interposition for benign (n=9) and malignant (n=10) lesions. Eighteen patients underwent trans-hiatal esophagectomy with cervical anastomosis, and one patient underwent thoraco-abdominal esophagectomy with intrathoracic anastomosis. Surgical morbidity was 36.8% (7/19). Anastomotic insufficiency and fatal mediastinal bleeding occurred in one patient each (5.3%). No cases of graft necrosis were observed, and no re-operations were necessary. In-hospital mortality was 15.8% (3/19), twice due to surgical complications (abdominal sepsis, mediastinal bleeding) and once due to pulmonary and cardiac failure. As a late complication, four patients (21.1%) developed anastomotic strictures that necessitated repeated endoscopic dilatation.

Conclusions

Gastric tube interposition remains the method of choice for esophageal replacement. Colon interposition, however, is a valuable alternative with a good long-term function. Early mortality, however, remains a matter of serious concern.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kelling GE (1911) Oesophagoplastik mit Hilfe des Querkolons. Zentralbl Chir 38:1209–1212

    Google Scholar 

  2. von Hacker V (1914) Über Ösophagoplastik in Allgemeinen und über den Einsatz der Speiseröhre durch antethorakale Hautdickdarmschlauchbildung im Besonderen. Arch Klin Chir 105:973

    Google Scholar 

  3. Vuillet H (1911) De l’oesophagoplastie et des diverses modifications. Semin Med 31:529–534

    Google Scholar 

  4. Akiyama H, Miyazono H, Tsurumaru M, Hashimoto C, Kawamura T (1978) Use of the stomach as an esophageal substitute. Ann Surg 188:606–610

    CAS  PubMed  Google Scholar 

  5. Büchler MW, Baer HU, Seiler C, Schilling M (1996) A technique for gastroplasty as a substitute for the esophagus: fundus rotation gastroplasty. J Am Coll Surg 182:241–245

    PubMed  Google Scholar 

  6. Schilling MK, Büchler MW (2000) Fundus rotation gastroplasty: a modified gastric tube. Recent Results Cancer Res 155:145–150

    CAS  PubMed  Google Scholar 

  7. Uhl W, Strobel O, Friess H, Schilling M, Büchler MW (2002) Fundus rotation gastroplasty: rationale, technique and results. Dis Esophagus 15:101–105

    Article  CAS  PubMed  Google Scholar 

  8. Urschel JD (2001) Does the interponat affect outcome after esophagectomy for cancer? Dis Esophagus 14:124–130

    Article  CAS  PubMed  Google Scholar 

  9. Wittekind C, Wagner G (1997) UICC: TNM-Klassifikation maligner Tumoren, 5th edn. Springer, Berlin Heidelberg New York

  10. Hüttl TP, Wichmann MW, Geiger TK, Schildberg FW, Furst H (2002) Techniques and results of esophageal cancer surgery in Germany. Langenbecks Arch Surg 387:125–129

    Article  PubMed  Google Scholar 

  11. Huang MH, Sung CY, Hsu HK, Huang BS, Hsu WH, Chien KY (1989) Reconstruction of the esophagus with the left colon. Ann Thorac Surg 48:660–664

    CAS  PubMed  Google Scholar 

  12. Fürst H, Löhe F, Hüttl T, Schildberg FW (1999) Oesophagusersatz durch Interposition des an der A. mesenterica inferior gestielten Colon ascendens. Chirurg 70:1434–1439

    PubMed  Google Scholar 

  13. Isolauri J, Markkkula H, Autio V (1987) Colon interposition in the treatment of carcinoma of the esophagus and gastric cardia. Ann Thorac Surg 43:420–424

    CAS  PubMed  Google Scholar 

  14. Larson TC, Shuman LS, Libshitz HI, McMurtrey MJ (1985) Complications of colonic interposition. Cancer 56:681–690

    PubMed  Google Scholar 

  15. Lundell L, Olbe L (1991) Colonic interposition for reconstruction after resection of cancer in the esophagus and gastroesophageal junction. Eur J Surg 157:189–192

    CAS  PubMed  Google Scholar 

  16. Thomas P, Fuentes P, Giudicelli R, Reboud E (1997) Colon interposition for esophageal replacement: current indications and long-term function. Ann Thorac Surg 64:757–764

    CAS  PubMed  Google Scholar 

  17. DeMeester TR, Johansson KE, Franze I, Eypasch E, Lu CT, McGill JE, Zaninotto G (1988) Indications, surgical technique, and long-term functional results of colon interposition or bypass. Ann Surg 208:460–474

    CAS  PubMed  Google Scholar 

  18. Curet-Scott MJ, Ferguson MK, Little AG, Skinner DB (1987) Colon interposition for benign esophageal disease. Surgery 102:568–574

    CAS  PubMed  Google Scholar 

  19. Kolh P, Honore P, Degauque C, Gielen JL, Gerard P, Jacquet N (2000) Early stage results after oesophageal resection for malignancy—colon interposition vs. gastric pull-up. Eur J Cardiothorac Surg 18:293–300

    Article  CAS  PubMed  Google Scholar 

  20. Cerfolio RJ, Allen MS, Deschamps C, Trastek VF, Pairolero PC (1995) Esophageal replacement by colon interposition. Ann Thorac Surg 59:1382–1384

    Article  CAS  PubMed  Google Scholar 

  21. Negre J, Markkula H (1984) Esophagectomy and colon interposition for benign esophageal stricture. Acta Chir Scand 150:639–642

    CAS  PubMed  Google Scholar 

  22. Skinner DB (1980) Esophageal reconstruction. Am J Surg 139:810–814

    CAS  PubMed  Google Scholar 

  23. Larsson S, Lepore V, Cardillo G (1990) Replacement of the oesophagus with a segment of colon. Experience of 30 cases and technical considerations. Acta Chir Scand 156:789–793

    CAS  PubMed  Google Scholar 

  24. Isolauri J (1988) Colonic interposition for benign esophageal disease. Long-term clinical and endoscopic results. Am J Surg 155:498–502

    CAS  PubMed  Google Scholar 

  25. Bilosi M, Bernard A, Favre JP, Cheynel N, Viard H, Devevey JM (1999) Les coloplasties après oesophagectomie pour cancer. Etude rétrosprective de la morbidité et de la mortalité. Ann Chir 53:854–858

    CAS  PubMed  Google Scholar 

  26. Bernstein JM, Juler GL (1980) Colon interposition versus esophagogastrostomy for esophageal carcinoma. Am Surg 46:216–222

    CAS  PubMed  Google Scholar 

  27. Hankins JR, Cole FN, McLaughlin JS (1984) Colon interposition for benign esophageal disease: experience with 23 patients. Ann Thorac Surg 37:192–196

    CAS  PubMed  Google Scholar 

  28. Wain JC, Wright CD, Kuo EY, Moncure AC, Wilkins EW Jr, Grillo HC, Mathisen DJ (1999) Long-segment colon interposition for acquired esophageal disease. Ann Thorac Surg 67:313–317

    Article  CAS  PubMed  Google Scholar 

  29. Gaissert HA, Mathisen DJ, Grillo HC, Malt RA, Wain JC, Moncure AC, Kim JH, Mueller PR, DeAngelis R, Ottinger LW (1993) Short-segment intestinal interposition of the distal esophagus. J Thorac Cardiovasc Surg 106:860–866

    CAS  PubMed  Google Scholar 

  30. Schumpelick V, Dreuw B, Ophoff K, Fass J (1995) [Esophageal replacement—indications, technique, results]. Leber Magen Darm 25:21–26

    CAS  PubMed  Google Scholar 

  31. Birkmeyer JD, Siewers AE, Finlayson EVA, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137

    Article  PubMed  Google Scholar 

  32. Peters JH, Kronson JW, Katz M, DeMeester TR (1995) Arterial anatomic considerations in colon interposition for esophageal replacement. Arch Surg 130:858–862

    CAS  PubMed  Google Scholar 

  33. Whooley BP, Law S, Murthy SC, Alexandrou A, Wong J (2001) Analysis of reduced death and complication rates after esophageal resection. Ann Surg 233:338–344

    Article  CAS  PubMed  Google Scholar 

  34. Slotman GJ, Burchard KW, D’Arezzo A, Gann DS (1988) Ketoconazole prevents acute respiratory failure in critically ill surgical patients. J Trauma 28:648–654

    CAS  PubMed  Google Scholar 

  35. Schilling MK, Eichenberger M, Maurer CA, Sigurdsson G, Büchler MW (2001) Ketoconazole and pulmonary failure after esophagectomy: a prospective clinical trial. Dis Esophagus 14:37–40

    Article  CAS  PubMed  Google Scholar 

  36. Jeyasingham K, Lerut T, Belsey RH (1999) Revisional surgery after colon interposition for benign oesophageal disease. Dis Esophagus 12:7–9

    Article  CAS  PubMed  Google Scholar 

  37. DeMeester SR (2001) Colon interposition following esophagectomy. Dis Esophagus 14:169–172

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Visceral and Transplantation Surgery, University of Berne, Inselspital, Switzerland

    Pietro Renzulli, Alexander Joeris & Annemarie Hilt

  2. Department of Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Oliver Strobel, Waldemar Uhl & Markus W. Büchler

  3. Surgical Clinic, Hospital of Liestal, Liestal, Switzerland

    Christoph A. Maurer

Authors
  1. Pietro Renzulli
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alexander Joeris
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Oliver Strobel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Annemarie Hilt
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christoph A. Maurer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Waldemar Uhl
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Markus W. Büchler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Waldemar Uhl.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Renzulli, P., Joeris, A., Strobel, O. et al. Colon interposition for esophageal replacement: a single-center experience. Langenbecks Arch Surg 389, 128–133 (2004). https://doi.org/10.1007/s00423-003-0442-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-003-0442-y

Keywords

Search

Navigation